We participate with most insurance plans. Your insurance coverage and benefits are a contract between you and your insurance company. Please provide a copy of your insurance card at each visit.
Services Not Covered by Insurance
It is your responsibility to check with your insurance company to determine covered benefits. The patient/guarantor is responsible for 100% of charges the insurance company chooses not to cover, including but not limited to co-payments, deductibles, vaccines, developmental screenings, and after-hour/weekend appointment charges.
Well Child Visit Services
Well Child checks are preventive care services meant to evaluate the child's growth, development, discuss preventative care, and review and administer vaccinations. If you have additional concerns that you would like to address such as fever, asthma, ear infections, initiating/changing a medication, ADHD etc., or if your child is medically complex, your insurance company may bill you a second co-pay or apply this portion of your visit to your deductible. The physicians at ORP code accurately and by the Medicaid rules that govern all insurance plans, so we may bill for both a Well visit and a Sick/Medical concern in the same visit. This cost for the additional concerns may go patient responsibility.
Credit Card on File Policy
We participate with CardPointe, a secure Payment Processing Platform such as the ones used for online retail stores. The stored credit card can be used to pay co-pays and charges at future visits. This service is secure, encrypted, and our staff does not have knowledge of your credit card number.
Circumstances when your card would be charged by ORP include but are not limited to:
- Co-pays and insurance deductibles
- Missed or canceled appointments without appropriate notice (see below)
- Any non-covered services and/or denial of services allocated to patient responsibility
- Any amount not paid by your insurance 90 days after a corrected claim has been filed
This in no way will compromise your ability to dispute a charge or question your insurance company's determination of payment.
If your balance due is larger than $200.00, we will provide a courtesy call and email to let you know we will be charging your card on file or determine if you need to establish a payment plan.
For Patients Who Don't Have Insurance or Are Not Using Insurance
Per federal CMS rules, you have the right to request a Good Faith Estimate for the total cost of any non-emergency items and services. This includes related costs like medical tests and office fees. This is an estimate, not a bill. Please ask for a Good Faith Estimate at the time of scheduling your visit, and you will receive this in writing at least 1 business day before your appointment. For more information, go to cms.gov.
We offer a 25% discount to self-pay patients when paid in full the day of the visit.
Should you have extraordinary financial pressures; we will assist you with a payment plan. This plan will need to be IN WRITING with our billing department prior to scheduling future visits. No balance over $500.00 can be carried on a family account unless a payment plan has been signed and the arrangement is being followed. The balance should be paid off in the next 12 months.
There is a $50 no-show fee that will be charged to the credit card on file. Cancellation policy: Speak to an ORP employee at least 24 hours in advance for Well Child Checks or Medicine/Behavioral consults or Medicine recheck visits, or at least 4 hours for office acute care visits or vaccine appointments. After 3 missed appointments, we reserved the right to dismiss the family from the office.
Form and Letter Fee (daycare forms, school forms, camp, sports, allergy, individual school or travel letters, etc.)
Effective 1/1/2023, there will be a $10 fee (per child, per form) for forms that are completed outside of a well care scheduled visit. The office spends about 600+ hours a year completing forms outside of the child's visit. Most are completed in a timely way, but any form that needs "RUSH" completion of < 3 business days will have a charge of $30.
Individual letters from the physician will incur a fee of $10/letter. Letters to return to activities or school excuses are free. Forms that can be completed during the scope of the visit are free.
Copying Medical Records
With your written consent, we will provide you with a copy of your child's medical record for a fee of $20 per child.
After-hour Phone Nurse Triage
After 8 pm (5 pm on Fridays) and on holidays, our phones transfer to an answering service. If you need medical triage advice, the call will be transferred to the Wake Med Nurse Triage services. A registered nurse will answer, address urgent concerns, and can page the on-call MD if needed. There is a $15 charge for calls that need the Wake Med nurse triage service, and this will be billed directly to you. We will waive this free for calls regarding newborns < 90 days old or calls where the patient is instructed to go to the Emergency Room based on their severity of illness.
Keeping a credit card on file prevents most service charges. Service charges are only accrued if there are late payments, inaccurate insurance information, or failure to pay bills.
- $15 administrative fee will be charged if the co-pay is not received within 48 hours of service.
- $35 administrative service charge will be added for:
- Re-filing of insurance due to incomplete or incorrect information given at the time of service, including if the insurance has been terminated.
- Administrative fee associated with accounts turned over to collection agencies.
- Returned checks.
- Any amount not covered by the patient's insurance including applicable deductibles, additional copays, etc. will be due 30 days from the time of the service. Late payments will incur an additional $10 per month billing fee.
- Accounts will be turned over to a collection agency if past due 90 days or more. Failure to pay the balance may result in discharge from the practice. The family is responsible for all collection costs involved with the collection of your account including court costs, reasonable attorney fees, and all other expenses incurred with collection if there is a default on any unpaid balance.
Printable Financial Policy
The physicians and staff of Oberlin Road Pediatrics fully support the efficacy and safety of vaccines. We follow the American Academy of Pediatrics (AAP) standardized schedule for implementation of vaccines, and the North Carolina State Law as the minimum requirement for vaccine administration for our patients. Oberlin Road Pediatrics expects our patients to be immunized on time, starting with the Hepatitis B vaccine in the neonatal period. If you are transferring your child into our practice from another medical provider, we will review the child's immunization records. If we determine that your child is significantly behind on shots, you will be asked to schedule a vaccine consultation with one of our physicians before we will see your child as a patient. We will work with new families to comply with vaccine recommendations and get back on track. However, if a requested vaccine consultation does not occur or if you are not willing to comply with NC vaccination laws, then Oberlin Road Pediatrics is not the right practice for your family, and we will not accept the child as a new patient. We are happy to discuss your questions about vaccines during Well Child appointments. If there are extensive concerns or questions, parents will need to set up a separate vaccine consultation appointment. It is important to understand that this visit may not be covered by insurance and parents will be responsible for paying for this consultation at the time of service, which may range in cost from $100 to $200 depending on the amount of time spent with the physician.
Family Behavior Policy
This practice is a family-friendly pediatric office caring for impressionable young children and their families. Although occurrences are rare, Oberlin Road Pediatrics feels strongly that our patients, their families, and our staff deserve to be protected from verbal abuse and aggressive behavior. We are very aware that families under physical and emotional stress might not be on their best behavior. However, we all need to respect each other and to "follow the golden rule". We understand that disagreements may occasionally occur, and we encourage you to discuss these matters with us in a civil manner. We encourage constructive criticism as we only improve when we know we are doing things wrong. However, when discussions/conversations become overheated or rude, we have a "Three Strikes you are out" policy. This behavior will be documented in the family's chart, and the parents will receive a letter with each infraction. If a third letter is sent, then the family is dismissed from our practice. In addition, we have a "No Tolerance" policy when behavior becomes abusive, threatening, or aggressive. This behavior will be documented in the family's chart and will result in immediate dismissal. Depending on the degree of infraction, we reserve the right to involve Child Protective Services, law enforcement, and other appropriate agencies should we deem them necessary. Lastly, we ask that families refrain from wearing crude graphics and language on clothing and using offensive language.
After Hours Appointment Policy
- Evening and weekend appointments are for urgent care visits and only for those who are established ORP patients. There is an after-hours fee that we bill your insurance that you could be responsible for depending on your insurance plan.
- Evening clinic is from 6-7 pm Monday through Thursday, and weekend clinic is Saturday and Sunday from 9 am-1 pm.
- The phone nurse takes the messages in the order received. Appointments are offered based on availability and are scheduled in sequential order to allow our physicians to see as many patients as possible.
- If a family cancels or no shows for an evening weekday appointment without giving us a 4-hour notice, the family's account will be charged a $50 no show fee.
- If a family cancels or no shows for a same-day weekend appointment, the family's account will be charged a $50 no show fee.
Patients arriving more than fifteen minutes late for an appointment may be asked to reschedule.
Work-In Sibling Appointments
We understand that bringing all the kids to the office is hard. However, "squeezing in" an unscheduled sibling visit can delay the physician for the rest of the scheduled appointments. Please schedule a separate visit for each child that you would like examined.
Seeing Minor Children without a Parent
Children less than 18 years of age are legal minors and will not be seen without the parent or guardian. We cannot see children without authorized caretakers. Written permission must be in the chart in order for us to see children with a non-parent or guardian, also known as a proxy caretaker.
- If you need a non-guardian to bring your child in, please print and complete this form: Consent by Proxy for non-urgent Care
- To have your teenager able to seek care independently, please print and complete this form: Consent for Underaged Teen Care
HIPAA Notice of Privary Policies
Oberlin Road Pediatrics follows all the HIPAA regulations. Medical information will not be released unless we have written authorization from you in the office.
In those families where there is a separation or divorce or a change in guardianship, we must have on file a court document indicating which parent/guardian is authorized to provide medical care, make medical decisions, and receive medical information on the child(ren). If a court document is not available, then the primary caregiver is responsible for notifying our office in writing of the above information as soon as there is a change in guardianship or custodial status.